Cardiac chiari network as an etiology for embolic stroke

The Chiari network is a congenital remnant in the right atrium. It is not commonly associated wtih clinical complications. We report the first case of medically treated embolic stroke in a patient with a cardiac Chiari network and a patent foramen ovale. A 59-year-old woman without cardiac history or signs presented with multiple cerebral infarctions in both the anterior and posterior cerebral circulations. Standard evaluation for cerebral infarction was unrevealing. Transesophageal echocardiography demonstrated a Chiari network in the right atrium and a right-to-left shunt. The Chiari network appeared thickened. After anticoagulation with warfarin, the patient developed no new symptoms of stroke, and repeat transesophageal echocardiography showed resolution of the presumed thrombus on the Chiari network. In workup of patients with ischemic strokes of unknown etiology, transesophageal echocardiography should be considered as an important method for comprehensive evaluation of the right atrium.